Premium Financing Broker

Premium Financing for Whole Life Insurance

If you are an insurance professional interested in obtaining a free quotation for Premium Financing for Whole Life Insurance from Strategic Wealth Advisors Network, for one of your clients, please complete the form below.

If you have questions or would like to discuss your options further, please call 631-262-9254.

Please note a * symbol indicates a required field.

First Insured

Date of Birth*

Occupation*

Risk*

Smoker Standard Preferred

Rating*

City*

State*

Zip*

Any known health conditions*

If there is a second insured, please continue.

Second Insured

Date of Birth

Occupation

Risk

Smoker Standard Preferred

Rating

City

State

Zip

Any known health conditions

Life Insurance Information

Life Insurance Need (Purpose)*

Life Insurance Death Benefit Need (Amount)*

Beneficiary Information*

Additional Financial Data

Cash/Cash Equivalents*

Gross Income*

Marketable Securities*

Expenses*

Real Estate*

Net Income*

Business*

Qualified Retirement Plan*

Additional Information

Other Assets*

Total Net Worth*

So that we can send you a free quote for your client, please record your information below:

Insurance Professional Name*

Phone (enter as xxx-xxx-xxxx)*

E-mail*

Please use the space below for comments or special requests.

CAPTCHA Code:*

Registered Representative offering Securities through American Portfolios Financial Services, Inc. (APFS). Member FINRA/SIPC. Investment Advisory Services are offered through G&G Planning Concepts, Inc. which is not affiliated with APFS.

Any opinions expressed in this forum are not the opinion or view of American Portfolios Financial Services, Inc. (APFS) or American Portfolios Advisors, Inc. (APA) and have not been reviewed by the firm for completeness or accuracy. These opinions are subject to change at any time without notice. Any comments or postings are provided for informational purposes only and do not constitute an offer or a recommendation to buy or sell securities or other financial instruments. Readers should conduct their own review and exercise judgment prior to investing. Investments are not guaranteed, involve risk and may result in a loss of principal. Past performance does not guarantee future results. Investments are not suitable for all types of investors.

	Michael Fliegelman
	CLU, ChFC, AEP, CLTC, RFC
	Phone: 631-262-9254